Ankle Sprains
Ankle Sprains Injury
Ankle sprains are the most common injury by far and more than 25,000 people sprain their ankles in the U.S. every day. Perhaps it’s because they are so common that many people minimize ankle sprains as insignificant and they often ignore them, not seeking treatment until the injury is quite far along. The fact remains that each ankle sprain is different and based on the mechanics of the sprain- how it happened, which direction things twisted – the treatment, recovery time, and prognosis are different. If not properly evaluated early and treated, ankle sprains often develop into more serious, painful, longer-term problems like chronic ankle instability and/or arthritis at the ankle joint.
Simply put, ankle sprains are caused by an unnatural twisting of the ankle. The abnormal forces that are put on the ankle bones and the bones of the foot during a sprain often result in one or more ligaments on the outside (or, less commonly, the inside) of the ankle to be stretched or even torn. It is this ligament stretching and/or tearing that causes the swelling, bruising, and immense pain associated with ankle sprains.
Treatment
“R.I.C.E.” – Rest, Ice, Compress, and Elevate
If you have sprained your ankle there are a few things you can do immediately to ensure that you start off treating this right, even before going to your podiatrist and getting evaluated. Initial treatment is “R.I.C.E.” – Rest, Ice, Compress, and Elevate:
- Resting the ankle and applying ice to reduce swelling is very important in the initial 72 hours.
- Icing the ankle as soon as possible after the injury is key. Think about what happens when a football player falls down on the field. The team doctor doesn’t come running with three Advil and a cup of water, they come running with ice! Ice is an immediate anti-inflammatory as it causes vasoconstriction, reducing blood flow to the area that would cause this area to swell.
- Compressive bandages also may be used to immobilize and support the injury, though many of the store-bought, over-the-counter wraps are too compressive and if they are improperly applied can do more harm than good.
- Elevation is key. Keeping your foot level (i.e., outstretched on a sofa or up on a chair) is the bare minimum you should be doing. Ideally, you would really prop your leg up on a number of pillows and try to get your foot and ankle above the level of your heart. This prevents swelling which increases the pain and likelihood that this will heal more slowly. Ideally you wouldn’t get up and walk or stand more than to go from your bed to your couch, or a quick trip to the restroom. The less you are in an upright/vertical position and the more you are laying down with your leg elevated and your ankle iced, the better.
One word of caution: It is possible to over-ice your foot and ankle so be careful when icing your ankle to limit the ice to 20 minutes an hour. Ideally you would follow a cycle of 20 minute of icing followed by 40 minutes of no ice, and then repeat. There is no need to ice when sleeping, but definitely try and keep your leg outstretched and even on a pillow if you can.
Ankle Sprain Examination
When you get to see you podiatrist, they will need to evaluate your ankle sprain. Much if this is done via physical examination. Depending on what they find on physical exam, they might decide to perform an x-ray to ensure that there wasn’t a fracture associated with this sprain. Sometimes an ultrasound or sonogram of the ankle can be helpful in identifying the soft tissues structures that are injured. In more severe case or sprains in athletes, your doctor may need to send you out for an MRI which gives the most detail on both the bone and soft tissue injuries. It can also be very helpful in staging your ankle sprain which often can help determine your course of treatment and your recovery time.
Ankle sprains are typically classified into a staging system:
Grade 1 Ankle Sprains are the least severe type of ankle sprain. Typically the damage is minor and limited to stretching fo the ligament(s). This kind of ankle sprain usually is associated with some mild to moderate soreness and some minor swelling but it is not associated with ankle instability or muscle weakness. These sprains, typically take 2-4 weeks to heal when patients seek early diagnosis and care. Staying off it is key to making sure that this is more of a 2 week than a 4 week recovery.
Grade 2 Ankle Sprains are the next higher level of ankle sprain above a Grade 1. One of the distinguishing factors is the bruising associated with more significant swelling. This bruising (black and blue marks that often appear down on the inner or outer sides of the heel are a tell-tale sign that a ligament was at least partially torn. These injuries should not be self-treated and require medical supervision and intervention. Very often, doctors will use some sort of brace or boot to help stabilize the ankle after a Grade 2 ankle sprain so as to minimize movement around the partially torn ligament(s), allowing them to heal better and faster.
Grade 2 ankle sprains typically heal within 6-8 weeks but that is when there is early intervention, diagnosis, and treatment. Grade 2 sprains that do not get treated in the initial few days of the injury can lead more than two months of pain and swelling in addition to delayed healing of the ligament, causing scar tissue to form.
Grade 3 Ankle Sprains are severe, and associated with extensive bruising and swelling from total rupture of one or more of the ankle ligaments. These must not be treated at home and they require early and aggressive intervention in order to stabilize the ankle, take the pressure off these injured ligaments, and avoid permanent damage to the ankle joint. These injuries are often associate with an avulsion fracture- a type of fracture where a tiny little chip of bone rips off the tip of one more more of the ankle bones, when the ligament is torn.
Recovery time from Grade 3 ankle sprains is really quite variable and depends on a number of factors including the health and fitness of the injured person, their age, their activity level, and how quickly they came in for treatment. Recovery times range from 3 to 6 months but they can definitely take even longer.
The most serious ankle sprains, especially in competitive athletes, may not heal properly despite all of the best interventions. In those cases, the do require surgery to repair or tighten the torn ligaments.
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